ABSTRACT
BACKGROUND: Paragonimus, is a globally distributed trematode, with human disease limited to endemic regions. It can be transmitted to humans through ingestion of intermediate hosts that are crustaceans. Most symptomatic infections consist of pulmonary disease, and in aberrant migration of immature flukes, extrapulmonary manifestations may occur. These presentations are relatively uncommon and may affect various organs with atypical Clinico-radiological pathologies that are often challenging to diagnose. Pericardial involvement has scarcely been reported before. Furthermore, the management, clinical outcomes and potential complications of this involvement remain unclear. CASE REPORT: Our patient is a 31-year-old Nepalese male who presented with abdominal distension and lower limb oedema. Initial work up revealed pericardial effusion, and analysis was suggestive of exudative lymphocytic effusion. Supported by positive QuantiFERON result along with his demographic data, the patient was treated presumptively as a case of tuberculous pericarditis, despite the negative initial Mycobacterial Tuberculosis work up. During follow up, the patient lacked clinical response and repeated echocardiography showed signs of tamponade with concomitant pleural effusion. subsequently video-assisted-thoracoscopy pericardial window along with pericardial and pleural biopsy were performed. Histopathological examination of the biopsied tissue revealed non-necrotizing granulomas containing a parasitic egg suggestive of Paragonimus. Fortunately, the patient received treatment with praziquantel and subsequently made good clinical recovery. CONCLUSION: Diagnosis of extrapulmonary Paragonimus infection can be challenging given its rarity and clinical picture mimicking other infectious aetiologies. Pericardial involvement is seldom reported in the literature and clinical suspicion should be raised particularly when dealing with atypical presentations and relevant demographic data.
ABSTRACT
PURPOSE: To compare the outcomes of trabeculectomy with 5-fluorouracil (5-FU) versus Ologen™ implant in patients with primary open-angle glaucoma. METHODS: A retrospective chart review was performed of patients with primary open-angle glaucoma who underwent trabeculectomy using either Ologen or 5-FU over 12 consecutive months. The patients had moderate-to-advanced primary open-angle glaucoma and uncontrolled intraocular pressure (IOP) on maximally tolerated medical treatment. Fornix-based trabeculectomy was performed on all patients by the same surgeon. The outcomes that were recorded and analyzed included the IOP level and number of glaucoma medications before and after surgery as well as the complications. All patients were followed for at least 3 months. RESULTS: A total of 58 eyes (of 47 patients) were included in this study. The eyes were divided into 2 groups: the 5-FU group (n = 30, 51.7%) and the Ologen group (n = 28, 48.3%). The demographics and preoperative clinical features were not significantly different between the 2 groups. Repeated-measures analysis showed a significant decrease in IOP after trabeculectomy in both groups, with a marked decrease at day 1 after surgery. The amount of relative change at postoperative day 1 was significantly higher in the Ologen group (62.1 vs. 45.2%; p = 0.025). After this, there were no significant changes over time in IOP measurements in either group. In all the eyes, there was a significant drop in the number of antiglaucoma medications used after the surgery (p < 0.005), i.e. from 4.0 to 1.4 and from 4.3 to 1.0 in the 5-FU and Ologen groups, respectively, with no significant differences between groups (p = 0.303). Complications were few and minor in both groups. Bleb revision was needed in 2 eyes in the 5-FU group and in 4 eyes in the Ologen group. CONCLUSION: The efficacy and safety of trabeculectomy with 5-FU was similar to that with Ologen. Further studies with a larger number of patients and longer follow-up periods are needed.
